Triglycerides
Triglycerides are the main fat carried in blood. Several sources set 150 mg/dL as the upper cut point for fasting adults, and very high levels are tied to pancreatitis. Higher levels go with more heart disease in cohorts and genetic studies, yet trials that lowered triglycerides gave mixed results. Results rise after meals and vary about 23% within one person.
- Status
- Part of the standard lipid panel, ordered by a clinician and also sold direct to consumers by some US laboratories. FDA classifies triglyceride test systems as class I devices exempt from premarket notification, and its product classification also lists over-the-counter triglyceride tests [1].
- Measures
- The amount of triglyceride, a fat, in serum or plasma [1].
- Also called
- TG, TRIG, trigs, triglyceride, serum triglycerides, plasma triglycerides, fasting triglycerides, non-fasting triglycerides, nonfasting triglycerides, triacylglycerol, TAG
- Tested for
- heart attack risk, stroke risk, pancreatitis risk, cholesterol check, metabolic syndrome, insulin resistance, checking response to diet or triglyceride-lowering drugs
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Linked in research3
- ModerateShown in genetic studies to track coronary heart disease, an effect that followed the number of ApoB-carrying particles more than triglycerides themselves.
- ModerateLinked to more deaths at higher levels: 9% more at 150 to 199 mg/dL and 20% more at 200 mg/dL or above in a meta-analysis of cohorts.
- LimitedOne cohort of 116,550 Danish adults linked non-fasting triglycerides of 177 mg/dL and above to more acute pancreatitis, about 9 times more at 443 mg/dL or above.
Reported risks0
No risks sourced yet.
Reference ranges
Each range is the one its source published, in mg/dL. Also reported in mmol/L. Where sources differ, each is shown.
National Cholesterol Education Program, Adult Treatment Panel III, 2001
Adults aged 20 and older, from a fasting lipoprotein profile · [2]
| Range | What the source calls it |
|---|---|
| below 150 mg/dL | "normal" |
| 150 to 199 mg/dL | "borderline-high" |
| 200 to 499 mg/dL | "high" |
| 500 or above mg/dL | "very high" One to see a doctor about |
The panel based this classification on the finding that elevated triglycerides are an independent risk factor for coronary heart disease. At 500 mg/dL or above it states that the first aim of therapy is to prevent acute pancreatitis. The panel also used 150 mg/dL or above as one of five defining levels for the metabolic syndrome [2].
American Heart Association and American College of Cardiology cholesterol guideline, 2018, risk-enhancing factor
Adults aged 40 to 75 without diabetes, being assessed for risk of a first cardiovascular event · [3]
| Range | What the source calls it |
|---|---|
| below 175 mg/dL | No name given |
| 175 or above mg/dL | "persistently elevated, primary hypertriglyceridemia" |
This is the level the guideline lists as a risk-enhancing factor, with a note that it is ideally confirmed on 3 measurements. It is not the guideline's full classification of high triglycerides, which is not reproduced here. The same table prints the metabolic syndrome factor as above 175 mg/dL. The guideline converts triglycerides to mmol/L by dividing mg/dL by 88.6 [3]. A 2026 guideline from the same bodies retires and replaces this one [4].
European Society of Cardiology and European Atherosclerosis Society guideline, 2019
Adults, as part of cardiovascular risk assessment · [5]
| Range | What the source calls it |
|---|---|
| below 150 mg/dL | "indicates lower risk" |
| 150 or above mg/dL | No name given |
The guideline sets no treatment goal for triglycerides. Its table reads "No goal, but <1.7 mmol/L (<150 mg/dL) indicates lower risk and higher levels indicate a need to look for other risk factors." It states that drug treatment may be considered in high-risk patients above 2.3 mmol/L (200 mg/dL), and that the risk of pancreatitis is clinically significant above 10 mmol/L (880 mg/dL) [5].
European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine consensus on laboratory reporting, 2016, fasting sample
Adults with a fasting sample, as values for laboratories to flag on reports · [6]
| Range | What the source calls it |
|---|---|
| below 150 mg/dL | No name given |
| 150 to 880 mg/dL | "abnormal" |
| above 880 mg/dL | "life-threatening" |
The statement asks laboratories to flag results against desirable concentration cut points in place of a population reference interval. It set the fasting cut point at 1.7 mmol/L, 0.3 mmol/L below the non-fasting one, to match the mean maximal rise after habitual food intake. Above 10 mmol/L (880 mg/dL) it asks for separate reporting and referral because of the risk of acute pancreatitis. The authors converted mmol/L to mg/dL by multiplying by 88 and rounding to the nearest 5 mg/dL. The cut points assume an assay corrected for free glycerol, which most laboratories do not use [6].
European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine consensus on laboratory reporting, 2016, non-fasting sample
Adults with a non-fasting sample, as values for laboratories to flag on reports · [6]
| Range | What the source calls it |
|---|---|
| below 175 mg/dL | No name given |
| 175 to 880 mg/dL | "abnormal" |
| above 880 mg/dL | "life-threatening" |
The non-fasting cut point of 2 mmol/L (175 mg/dL) was taken from a study of women in which it gave the strongest cardiovascular risk prediction. The authors estimate that 27% of adults in a typical Western or Northern European country would be flagged at this cut point. The statement suggests a fasting sample may be considered when non-fasting triglycerides exceed 5 mmol/L (440 mg/dL) [6].
Endocrine Society clinical practice guideline on hypertriglyceridemia, 2012
Adults, from fasting triglyceride levels · [7]
| Range | What the source calls it |
|---|---|
| below 150 mg/dL | "normal" |
| 150 to 199 mg/dL | "mild hypertriglyceridemia" |
| 200 to 999 mg/dL | "moderate hypertriglyceridemia" |
| 1000 to 1999 mg/dL | "severe hypertriglyceridemia" A doctor, immediately |
| 2000 or above mg/dL | "very severe hypertriglyceridemia" A doctor, immediately |
The guideline bases the diagnosis on fasting levels after a 12-hour fast. It states that severe and very severe hypertriglyceridemia increase the risk for pancreatitis, and that mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease. Its severe band starts at 1,000 mg/dL, where Adult Treatment Panel III starts its highest band at 500 mg/dL [7].
European Atherosclerosis Society consensus statement on triglyceride-rich lipoproteins, 2021
Adults, with no distinction by sex · [8]
| Range | What the source calls it |
|---|---|
| below 100 mg/dL | "optimal" |
| 100 to 149 mg/dL | "borderline" |
| 150 to 499 mg/dL | "moderately elevated" |
| 500 to 880 mg/dL | "severe" One to see a doctor about |
| above 880 mg/dL | "extreme" A doctor, immediately |
The panel calls these working definitions and states that the cut points are arbitrary. It prints the bands with shared end points, as 100 to 150, 150 to 500 and 500 to 880 mg/dL (1.2 to 1.7, 1.7 to 5.7 and 5.7 to 10.0 mmol/L), so this page places each shared value in the higher band. The panel set the extreme band at the threshold for high risk of acute pancreatitis. It based the 100 mg/dL cut point on earlier guidelines and on findings that remnant particles become detectable above that level [8].
National Heart, Lung, and Blood Institute expert panel, 2011, children aged 0 to 9
Children aged 0 to 9 years · [9]
| Range | What the source calls it |
|---|---|
| below 75 mg/dL | "acceptable" |
| 75 to 99 mg/dL | "borderline" |
| 100 or above mg/dL | "high" |
Values come from an earlier US pediatric cholesterol panel. The borderline and high cut points represent approximately the 75th and 95th percentiles [9].
National Heart, Lung, and Blood Institute expert panel, 2011, ages 10 to 19
Children and adolescents aged 10 to 19 years · [9]
| Range | What the source calls it |
|---|---|
| below 90 mg/dL | "acceptable" |
| 90 to 129 mg/dL | "borderline" |
| 130 or above mg/dL | "high" |
Values come from an earlier US pediatric cholesterol panel. The borderline and high cut points represent approximately the 75th and 95th percentiles [9].
National Heart, Lung, and Blood Institute expert panel, 2011, young adults
Young adults, from data on people aged 20 to 24 · [9]
| Range | What the source calls it |
|---|---|
| below 115 mg/dL | "acceptable" |
| 115 to 149 mg/dL | "borderline high" |
| 150 or above mg/dL | "high" |
Values come from the Lipid Research Clinics Prevalence Study. The high cut point represents approximately the 90th percentile and the borderline band the 75th to 89th percentiles. The panel states these cut points are not identical to the adult classification of Adult Treatment Panel III [9].
What has been shown to move it
Shown to lower it30
Cholesterol and triglycerides
Shown to lower LDL by about 0.46 mmol/L and lower triglycerides in adults, in trials mostly from China and Hong Kong.
The numbers and sources
- Effect
- In 18 placebo-controlled trials (1,788 participants), berberine lowered LDL by 0.46 mmol/L (95% CI -0.62 to -0.30), total cholesterol by 0.48 mmol/L and triglycerides by 0.34 mmol/L, and raised HDL by 0.06 mmol/L. The HDL rise was seen in women and not in men [8]. A 27-trial meta-analysis found berberine combined with lipid drugs lowered cholesterol more than the drugs alone [4].
- Population
- Adults, mostly in mainland China and Hong Kong, for 4 to 24 weeks [8].
- Sources
- [4], [8]
- Caveats
- 15 of the 18 trials were in mainland China or Hong Kong [8].
Cholesterol and triglycerides
Shown to lower LDL by about 14 mg/dL and triglycerides by about 21 mg/dL in adults. HDL did not change overall.
A 2025 review of 82 RCTs (5,026 participants) also reported improved total cholesterol, LDL, HDL and triglycerides.
The numbers and sources
- Effect
- In 17 RCTs, Nigella sativa lowered total cholesterol by 15.65 mg/dL (95% CI -24.67 to -6.63), LDL by 14.10 mg/dL and triglycerides by 20.64 mg/dL. HDL did not change overall (0.28 mg/dL, 95% CI -1.96 to 2.53) and rose only with seed powder. Oil lowered total and LDL cholesterol more than powder [1]. A 2025 review of 82 RCTs (5,026 participants) also reported improved total cholesterol, LDL, HDL and triglycerides [2].
- Population
- Adults in placebo-controlled RCTs [1]. Trials of 1 to 48 weeks [2].
- Sources
- [1], [2]
- Caveats
- The 2025 abstract lists outcomes without effect sizes [2]. Neither review measured heart attacks or strokes.
Ezetimibe: LDL cholesterol and ApoB
Shown to lower LDL cholesterol about 18% more than placebo when taken alone, with ApoB about 16% lower, and to lower LDL further when added to a statin.
Compared with placebo [1][2]; a statin or fenofibrate alone [3][4]
The numbers and sources
- Effect
- Across 8 placebo-controlled 12-week trials, ezetimibe 10 mg lowered LDL cholesterol 18.58% more than placebo (95% CI 17.48 to 19.67), total cholesterol 13.46% more and triglycerides 8.06% more, and raised HDL cholesterol 3.00% [1]. In two label trials, LDL cholesterol fell 18% and ApoB 16% on ezetimibe against a 1% rise and 2% fall on placebo [2]. Added to a statin or fenofibrate, ezetimibe lowered LDL cholesterol, total cholesterol and triglycerides further and likely raised HDL [3]. After an acute coronary syndrome, time-averaged LDL was 53.7 mg/dL on simvastatin with ezetimibe against 69.5 mg/dL on simvastatin alone [4].
- Population
- 2,722 people with primary hypercholesterolemia in 8 trials [1]; 1,719 adults in two trials [2]; 23,499 people in 26 trials [3]; 18,144 patients [4].
- Sources
- [1], [2], [3], [4]
- Caveats
- Lipid trials alone lasted 12 weeks [1]. Heterogeneity was substantial in the combination analyses [3].
Triglycerides
Shown to lower triglycerides by about 15% in adults, more at higher doses.
The numbers and sources
- Effect
- Increasing long-chain omega-3 reduced triglycerides by about 15% in a dose-dependent way (high-certainty evidence). It had little or no effect on other blood lipids, adiposity or blood pressure [1]. In 23 RCTs of people with coronary heart disease, omega-3 lowered triglycerides (SMD -0.25, 95% CI -0.38 to -0.11), with a linear dose-response [2]. Across 21 trials in mixed populations, triglycerides fell 16.95 mg/dL (95% CI -23.25 to -10.66) [3]. In 9 trials of people with fatty liver disease, they fell 13.81 mg/dL (95% CI -24.56 to -3.06), with no significant effect in those who also had type 2 diabetes [4]. In 21 trials of metabolic syndrome, reductions ranged from about 25 to 57 mg/dL, largest above 2,000 mg a day [5].
- Population
- 86 RCTs with 162,796 adults at varying cardiovascular risk, lasting 12 to 88 months, mostly capsule supplements [1]; 2,061 patients with coronary heart disease [2]; 2,043 adults in 24 studies [3]; 528 patients with fatty liver disease [4]; about 1,950 adults with metabolic syndrome or its components [5].
- Sources
- [1], [2], [3], [4], [5]
- Caveats
- The Cochrane abstract reports the triglyceride effect as a percentage without a confidence interval [1]. The metabolic syndrome review reports subgroup reductions about three times the size of the other pooled estimates, from dose and duration subgroups rather than one overall estimate [5].
Cholesterol
Shown to lower total cholesterol about 10 to 17 mg/dL and LDL about 6 to 9 mg/dL in adults, more in those with high cholesterol.
A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL.
The numbers and sources
- Effect
- Across 39 trials, garlic lowered total cholesterol by 17 ± 6 mg/dL and LDL by 9 ± 6 mg/dL in people with total cholesterol above 200 mg/dL, when taken for longer than 2 months. HDL rose slightly and triglycerides did not change significantly [3]. A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL [4].
- Population
- Adults in 39 trials, effects reported in those with elevated cholesterol [3]. Adults in 108 trials [4].
- Sources
- [3], [4]
- Caveats
- The abstract of [3] describes earlier meta-analyses on this question as conflicting. The authors of [4] report larger effects in adults with unfavorable baseline risk factors and call for larger, longer, more rigorous trials. The two reviews disagree on triglycerides.
LDL cholesterol
Shown to lower LDL cholesterol by about 10%, about 16 mg/dL, in adults and children. Changes were not significant in adults with insulin resistance.
The numbers and sources
- Effect
- Across 14 studies with 531 participants, glucomannan lowered total cholesterol 19.28 mg/dL (95% CI -24.30 to -14.26), LDL 15.99 mg/dL (95% CI -21.31 to -10.67) and triglycerides 11.08 mg/dL (95% CI -22.07 to -0.09), with no change in HDL [1]. Across 12 studies with 370 participants, LDL fell 0.35 mmol/L (95% CI -0.46 to -0.25) and non-HDL cholesterol 0.32 mmol/L, about 10% and 7%. Apolipoprotein B did not change in 6 trials [2].
- Population
- Adults and children in RCTs [1][2].
- Sources
- [1], [2]
- Caveats
- Trials were small and short, with follow-up of at least 3 weeks in [2]. In 11 trials restricted to adults with insulin resistance-related conditions, lipid changes were not significant overall, with LDL and total cholesterol lower only in subgroups above 3,000 mg a day or at 4 weeks or less [3].
Triglycerides and HDL cholesterol
Shown to lower triglycerides by about 0.2 to 0.3 mmol/L and raise HDL cholesterol more than comparison diets in adults.
Compared with diets that did not restrict carbohydrates to the level of ketosis
The numbers and sources
- Effect
- Against low-fat diets over 12 months or more, triglycerides fell 0.18 mmol/L more (95% CI 0.08 to 0.27) and HDL rose 0.09 mmol/L more (95% CI 0.06 to 0.12) [1]. Across 27 RCTs, triglycerides fell 0.20 mmol/L (95% CI 0.11 to 0.29) and HDL rose 0.16 mmol/L (95% CI 0.09 to 0.23) against control diets [2]. In 62 studies, triglycerides fell 19.96 mg/dL (95% CI 13.81 to 26.10) and HDL rose 3.61 mg/dL (95% CI 1.44 to 5.57) [5]. In pre-diabetes and type 2 diabetes, triglycerides were 0.28 mmol/L lower at 12 months (95% CI 0.11 to 0.44) [6].
- Population
- Adults with and without obesity or type 2 diabetes [1][2][5][6].
- Sources
- [1], [2], [5], [6]
- Caveats
- Heterogeneity was 72.2% for triglycerides and 86.7% for HDL in [2]. The same reviews found LDL cholesterol rose (see Risks).
LDL cholesterol and ApoB
Shown to lower LDL cholesterol by about 4.8 mg/dL per daily ounce of tree nuts, and by 10.2 mg/dL at about 67 g a day, along with ApoB.
Compared with control arms without nuts [4]; control diets the abstract does not describe [5]
Triglycerides fell 20.6 mg/dL in people starting at 150 mg/dL or higher and not in others.
The numbers and sources
- Effect
- Per 1 oz (28.4 g) serving a day, tree nuts lowered total cholesterol by 4.7 mg/dL (95% CI 4.0 to 5.3), LDL cholesterol by 4.8 mg/dL (95% CI 4.2 to 5.5), ApoB by 3.7 mg/dL (95% CI 2.3 to 5.2) and triglycerides by 2.2 mg/dL (95% CI 0.5 to 3.8). HDL cholesterol, apolipoprotein A1 and blood pressure did not change significantly. Effects were stronger at 60 g a day or more and did not differ by nut type. ApoB fell more in people with type 2 diabetes (11.5 mg/dL) than in healthy people (2.5 mg/dL) [4]. Pooled individual data from 25 trials found a mean 67 g a day lowered total cholesterol by 10.9 mg/dL (5.1%) and LDL cholesterol by 10.2 mg/dL (7.4%). Triglycerides fell 20.6 mg/dL in people starting at 150 mg/dL or higher and not in others [5].
- Population
- 2,582 adults without cardiovascular disease in 61 trials of 3 to 26 weeks [4]. 583 adults with normal or high cholesterol not on lipid-lowering drugs, in 25 trials in 7 countries [5].
- Sources
- [4], [5]
- Caveats
- Trials were short and many are shared between the two analyses. Effects were largest in people with higher starting LDL cholesterol and lower body mass index [5].
Cholesterol and blood lipids
Shown to lower total and LDL cholesterol slightly, by about 0.3 mmol/L, with larger drops when more weight was lost.
HDL cholesterol fell 0.034 mmol/L and triglycerides 0.09 mmol/L.
The numbers and sources
- Effect
- Orlistat lowered total cholesterol by 0.30 mmol/L and LDL cholesterol by 0.27 mmol/L. HDL cholesterol fell 0.034 mmol/L and triglycerides 0.09 mmol/L. Lipoprotein(a) did not change. LDL lowering was larger with more weight loss and shorter treatment [3]. An earlier systematic review also found greater falls in total and LDL cholesterol than with control [5].
- Population
- 33 RCTs [3]; 28 RCTs, 17 of them with 10,041 patients over a year [5].
- Sources
- [3], [5]
- Caveats
- The changes are small. The reviews do not separate the drug from the weight lost.
Cholesterol and triglycerides
Shown to lower total and LDL cholesterol and triglycerides more than comparison diets in adults, though some pooled results depended on single trials.
Compared with control diets the source does not describe [1], [3]; a diet following the Nordic Nutrition Recommendations [4]; a control group the source does not describe [5]
The numbers and sources
- Effect
- In people with metabolic disorders, total cholesterol fell 0.32 mmol/L (95% CI 0.15 to 0.49), triglycerides 0.29 mmol/L (95% CI 0.16 to 0.42) and LDL 0.35 mmol/L (95% CI 0.03 to 0.67) more than on control diets [5]. In 19 RCTs, total cholesterol fell 0.15, LDL 0.24 and triglycerides 0.16 more, in units the abstract does not state [3]. A third review found lower total cholesterol, triglycerides and LDL and higher HDL [1]. Triglycerides fell more than on a Nordic guideline diet at 6 and 24 months [4].
- Population
- Adults with metabolic disorders [5]; adults in 19 RCTs [3]; adults in 8 RCTs [1]; postmenopausal women with obesity [4].
- Sources
- [1], [3], [4], [5]
- Caveats
- In [1], lipid results changed when single studies were removed.
Blood fats
Shown to lower triglycerides in pooled trials of aerobic training, with HDL cholesterol rising modestly in two reviews and not changing overall in a third.
Compared with control groups in randomized trials [8][9]; no exercise, or diet alone [10]
In sedentary adults with metabolic syndrome factors, aerobic training lowered triglycerides by 0.17 to 0.18 mmol/L, total cholesterol by 0.19 to 0.29 mmol/L and LDL cholesterol by 0.12 to 0.20 mmol/L, and raised HDL cholesterol by 0.05 to 0.10 mmol/L.
The numbers and sources
- Effect
- HDL cholesterol rose by 2.53 mg/dL against controls, from a minimum of about 120 minutes of exercise a week, and rose more with longer sessions [8]. In sedentary adults with metabolic syndrome factors, aerobic training lowered triglycerides by 0.17 to 0.18 mmol/L, total cholesterol by 0.19 to 0.29 mmol/L and LDL cholesterol by 0.12 to 0.20 mmol/L, and raised HDL cholesterol by 0.05 to 0.10 mmol/L [9]. In adults with overweight or obesity, aerobic exercise lowered triglycerides and did not change total, HDL or LDL cholesterol overall [10].
- Population
- 25 randomized trials [8]. 2,990 participants in 48 data sets of trials of at least 12 weeks [9]. 619 adults with overweight or obesity in 9 trials [10].
- Sources
- [8], [9], [10]
- Caveats
- Changes were modest. The populations differed across reviews, which may explain the HDL difference.
LDL cholesterol
Shown to lower LDL cholesterol by about 4.8 mg/dL, 3% to 4%, at a median 25 g of soy protein a day against non-soy protein, in pooled trials.
Compared with non-soy protein [4]; control groups the abstract does not describe [5]
In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%.
The numbers and sources
- Effect
- Across 41 trials identified by the FDA, soy protein at a median 25 g a day for a median 6 weeks lowered LDL cholesterol by 4.76 mg/dL (95% CI -6.71 to -2.80) and total cholesterol by 6.41 mg/dL (95% CI -9.30 to -3.52), with no dose-response or publication bias. About 75% of trials showed a fall, though few were individually significant [4]. In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%. Falls were larger in men and in people with high cholesterol. Tablets of extracted isoflavones did not lower total cholesterol [5].
- Population
- Adults with baseline LDL cholesterol of 110 to 201 mg/dL in 43 trials [4]. 23 randomized trials published 1995 to 2002 [5].
- Sources
- [4], [5]
- Caveats
- Heterogeneity was moderate (I² 55% for LDL) [4]. Most trials lasted weeks. The FDA has proposed revoking the soy protein heart claim [1], which the review authors attribute to a perceived lack of consistent LDL reduction in trials [4].
Blood sugar and blood lipids
Shown to lower fasting glucose about 6 mg/dL and triglycerides about 14 to 18 mg/dL, mostly in people with obesity, diabetes or metabolic syndrome. HDL did not change.
The numbers and sources
- Effect
- Fasting glucose fell by 5.9 mg/dL (95% CI -10.7 to -1.0) and triglycerides by 18.3 mg/dL (95% CI -25.6 to -11.0). HDL cholesterol did not change [4]. A second meta-analysis found fasting glucose 5.9 mg/dL lower, HbA1c 0.21% lower, triglycerides 14.4 mg/dL lower and LDL cholesterol 5.1 mg/dL lower [5].
- Population
- 25 RCTs, 1,024 participants [4]; 34 RCTs [5].
- Sources
- [4], [5]
- Caveats
- Most trials were short and enrolled people with obesity, diabetes or metabolic syndrome. Neither review measured hard outcomes such as heart attacks or diabetes onset.
Cholesterol and triglycerides
Shown to lower triglycerides about 13 mg/dL and LDL about 6 mg/dL in adults with metabolic conditions. Smaller reviews found no significant LDL change.
Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL.
The numbers and sources
- Effect
- An umbrella review re-pooled 72 RCTs. Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL [10]. In 27 RCTs in prediabetes and diabetes, triglycerides fell 13.73 mg/dL, total cholesterol 5.24 mg/dL and LDL 5.72 mg/dL (95% CI -8.62 to -2.82), and HDL rose 2.14 mg/dL [11]. In 11 RCTs (662 people with metabolic disease), triglycerides and total cholesterol fell, while LDL and HDL did not change significantly under random-effects models [12]. With piperine added, 16 RCTs (1,038 participants) showed lower triglycerides and total cholesterol and no significant LDL change [13].
- Population
- Adults with noncommunicable diseases, with larger effects in type 2 diabetes [10]; adults with prediabetes or diabetes [11]; adults with metabolic disorders [12][13].
- Sources
- [10], [11], [12], [13]
- Caveats
- I² was 94% to 98% in the umbrella review [10] and above 80% in the diabetes review, which rated certainty low for every outcome [11]. The LDL drop did not reach significance in two smaller reviews [12][13]. The umbrella review found the total cholesterol and HDL changes smaller than their minimal clinically important differences [10].
Blood sugar and blood lipids
Shown to lower fasting glucose by about 16 mg/dL and triglycerides in people with prediabetes or type 2 diabetes. Reviews disagree on LDL and total cholesterol.
The numbers and sources
- Effect
- In prediabetes and type 2 diabetes, astaxanthin lowered fasting glucose by 16.1 mg/dL (95% CI -29.0 to -3.3), HbA1c by 0.34 points, triglycerides by 20.9 mg/dL, total cholesterol by 12.2 mg/dL and LDL by 9.4 mg/dL, and raised HDL by 3.0 mg/dL. HOMA-IR, weight and BMI did not change [4]. At 6 to 20 mg a day, a second meta-analysis found higher HDL and lower triglycerides, with no change in LDL or total cholesterol [5]. In adults at risk of metabolic syndrome, effects on total cholesterol and systolic pressure were marginal, and LDL fell [6].
- Population
- 403 patients in 9 RCTs [4]; 8 studies with 11 results [5]; 321 adults in 7 RCTs [6].
- Sources
- [4], [5], [6]
- Caveats
- The reviews disagree on LDL and total cholesterol. All pooled small trials.
Triglycerides and HDL cholesterol
Shown in two trials to lower triglycerides more than higher-carbohydrate diets in adults with overweight, while a third found similar heart risk changes across four diets.
Compared with the Zone, LEARN and Ornish diets [7]; the Zone, Weight Watchers and Ornish diets [8]; a conventional low-calorie, high-carbohydrate, low-fat diet [9]; a high-carbohydrate, high-fibre diet and the high-protein Zone diet [11]
Triglycerides fell 0.30 mmol/L more than on a high-carbohydrate diet in insulin-resistant women.
The numbers and sources
- Effect
- HDL rose and triglycerides fell more on Atkins than on a conventional diet through most of a year, with no difference in total or LDL cholesterol after 3 months [9]. Triglycerides fell 0.30 mmol/L more than on a high-carbohydrate diet in insulin-resistant women [11]. At 12 months, Atkins secondary outcomes, including lipids, were comparable with or more favorable than Zone, LEARN and Ornish [7]. In another trial, each of four diets lowered the LDL to HDL ratio by about 10%, with no significant change in blood pressure or glucose [8].
- Population
- Adults with obesity [9]; insulin-resistant women [11]; premenopausal women [7]; adults with cardiac risk factors [8].
- Sources
- [7], [8], [9], [11]
- Caveats
- Small trials with high dropout. Blood markers, not heart attacks or strokes.
HbA1c in people with type 2 diabetes using step counters
Mixed results: two meta-analyses found no change in HbA1c with step counters in type 2 diabetes, and a later one of 24 trials found a 0.22% drop.
Compared with control groups in randomized trials [10]; control groups in controlled trials [12]; control participants [13]
A review of 24 randomized trials found HbA1c fell 0.22% (95% CI -0.4 to -0.05, I² 77%) and triglycerides fell 13.11 mg/dL (95% CI -25.21 to -1.02) against control participants.
The numbers and sources
- Effect
- Step counter use did not change HbA1c (WMD 0.02%, 95% CI -0.08 to 0.13), with or without a goal [10]. A review of 12 trials found no differences in HbA1c, BMI, blood pressure or lipids [12]. A review of 24 randomized trials found HbA1c fell 0.22% (95% CI -0.4 to -0.05, I² 77%) and triglycerides fell 13.11 mg/dL (95% CI -25.21 to -1.02) against control participants [13].
- Population
- 1,423 participants in 10 trials [10]. 1,458 participants in 12 trials [12]. 1,969 patients in 24 trials [13].
- Sources
- [10], [12], [13]
- Caveats
- All participants had type 2 diabetes. Heterogeneity was high in the positive review [13].
Fenofibrate: triglycerides, HDL and LDL cholesterol
Shown to lower triglycerides about 29% and LDL cholesterol 21% and to raise HDL 11% against placebo, with triglycerides 46% to 55% lower in severe high triglycerides.
Compared with placebo [7]
In severe high triglycerides, triglycerides fell 46.2% (baseline 432 mg/dL) and 54.5% (baseline 726 mg/dL) against -0.5% and +7.2% on placebo, while LDL cholesterol rose in both groups.
The numbers and sources
- Effect
- In four placebo-controlled trials of 3 to 6 months, fenofibrate at the 145 mg dose changed triglycerides by -28.9% against +7.7% on placebo, LDL cholesterol by -20.6% against -2.2%, total cholesterol by -18.7% against -0.4%, and HDL by +11.0% against +0.7%. ApoB fell 25.1% against a 2.4% rise. In severe high triglycerides, triglycerides fell 46.2% (baseline 432 mg/dL) and 54.5% (baseline 726 mg/dL) against -0.5% and +7.2% on placebo, while LDL cholesterol rose in both groups [7].
- Population
- 646 adults with high cholesterol or mixed dyslipidemia in 4 trials, and 147 adults with high triglycerides in 2 trials of 8 weeks [7].
- Sources
- [7]
- Caveats
- Label trials, short-term. The label reports rare severe paradoxical drops in HDL, listed under Risks [7].
Blood lipids
Shown to lower total cholesterol and triglycerides and raise HDL in controlled trials, more in people with diabetes. Sources disagree on LDL.
The numbers and sources
- Effect
- Across 15 RCTs, fenugreek lowered total cholesterol (-1.13, 95% CI -1.88 to -0.37), LDL (-1.26, 95% CI -2.09 to -0.43) and triglycerides (-1.07) and raised HDL (0.70, 95% CI 0.07 to 1.34) compared with control. Effects were larger in people with diabetes [3]. The 2023 diabetes meta-analysis reported lower total cholesterol and triglycerides, higher HDL, and no change in LDL [2].
- Population
- 281 people on fenugreek and 255 controls in controlled trials [3].
- Sources
- [2], [3]
- Caveats
- The sources disagree on LDL. The abstract of [3] does not state the units of its pooled estimates.
Liver enzymes and lipids in fatty liver disease (quercetin alone)
Shown to lower liver enzymes, LDL and triglycerides with quercetin alone in people with fatty liver disease, at very low to moderate certainty.
The numbers and sources
- Effect
- A 2025 meta-analysis of 7 RCTs (540 patients) with metabolic dysfunction-associated steatotic liver disease found that quercetin lowered ALT, AST, GGT, direct bilirubin and C-reactive protein, lowered total cholesterol, LDL and triglycerides, and raised HDL. BMI, body fat, kidney function and TNF-α did not change [10].
- Population
- 540 patients with fatty liver disease in 7 RCTs [10].
- Sources
- [10]
- Caveats
- GRADE certainty ranged from very low to moderate. Dose, baseline BMI and age may explain heterogeneity. The abstract gives no pooled effect sizes [10]. None of the trials measured senescent cells.
Cholesterol and triglycerides
Shown to lower triglycerides about 24 mg/dL and raise HDL slightly in adults, with no LDL change. One 10-week trial found no lipid change.
The numbers and sources
- Effect
- Across 14 trials with 623 subjects, total cholesterol fell 6.76 mg/dL (95% CI -12.39 to -0.59), triglycerides fell 24.21 mg/dL (95% CI -37.84 to -10.58) and HDL rose 2.95 mg/dL (95% CI 2.01 to 3.89). LDL did not change (-1.15 mg/dL, 95% CI -16.08 to 13.78). Changes were larger in trials longer than 8 weeks [5]. In the 10-week Korean trial, garcinia extract did not change triglycerides or total cholesterol compared with placebo [4].
- Population
- Adults in 14 RCTs [5]; 86 overweight adults [4].
- Sources
- [4], [5]
- Caveats
- Interventions were short and heterogeneity was significant [5].
Blood pressure and triglycerides
Mixed results: triglycerides fell more on higher-protein diets in two meta-analyses, while blood pressure fell slightly in one and did not differ in another.
Compared with diets with less protein
The numbers and sources
- Effect
- Across 74 trials, higher-protein diets lowered systolic (SMD -0.21, 95% CI -0.32 to -0.09) and diastolic blood pressure (SMD -0.18, 95% CI -0.29 to -0.06) and triglycerides (SMD -0.51, 95% CI -0.78 to -0.24). Total and LDL cholesterol, C-reactive protein and HbA1c did not change [6]. In energy-restricted trials, triglycerides fell 0.23 mmol/L more (95% CI 0.12 to 0.33), and blood pressure and total, LDL and HDL cholesterol did not differ [1].
- Population
- Adults in 74 trials [6] and in 24 weight-loss trials [1].
- Sources
- [1], [6]
- Caveats
- Restricting to studies at lower risk of bias reduced the triglyceride effect [6]. In type 2 diabetes, blood pressure changes were not significant [8].
Weight, blood sugar and lipids
Shown to lower BMI slightly, about 0.6 kg/m², and glucose, triglycerides and blood pressure in adults across several conditions, at low certainty for some.
The numbers and sources
- Effect
- In 18 RCTs (898 participants) of at least 4 weeks, inositol lowered BMI by 0.57 kg/m² (95% CI -1.10 to -0.03), waist circumference by 2.36 cm, glucose by 7.25 mg/dL, HOMA-IR by 1.21, triglycerides by 29.80 mg/dL, LDL cholesterol by 5.15 mg/dL, and systolic and diastolic pressure by 5.34 and 6.12 mm Hg [11].
- Population
- Adults in RCTs across several conditions [11].
- Sources
- [11]
- Caveats
- Certainty was low to very low for BMI, waist and blood pressure, and moderate for glucose, insulin and HOMA-IR. Heterogeneity was high for most outcomes, and the authors note a high risk of bias in the trials [11].
Blood pressure, cholesterol and blood sugar markers
Shown to lower blood pressure about 3/2 mmHg and LDL cholesterol and HbA1c slightly in adults, at low to moderate certainty.
Compared with no or minimal intervention, and another dietary intervention the abstract does not name [2]; a low-fat diet, a low-carbohydrate diet and the American Diabetes Association diet [7]; control diets the source does not describe [10]
In 9 RCTs (1,337 people at raised risk of diabetes or heart disease), HbA1c fell 0.18 points (95% CI -0.35 to -0.01), LDL 0.10 mmol/L and triglycerides 0.20 mmol/L.
The numbers and sources
- Effect
- Against no or minimal intervention, systolic blood pressure fell 2.99 mmHg (95% CI -3.45 to -2.53) and diastolic 2.0 mmHg (95% CI -2.29 to -1.71) at moderate quality, with little or no effect on LDL or HDL. Against other diets, LDL fell 0.15 mmol/L (95% CI -0.27 to -0.02) and triglycerides 0.09 mmol/L, with little or no effect on blood pressure [2]. In 9 RCTs (1,337 people at raised risk of diabetes or heart disease), HbA1c fell 0.18 points (95% CI -0.35 to -0.01), LDL 0.10 mmol/L and triglycerides 0.20 mmol/L. Fasting glucose, insulin, insulin resistance and HDL did not change [10]. Over 12 months or more, blood pressure and lipids changed about as much as on comparator diets [7].
- Population
- Healthy adults and adults at high cardiovascular risk [2]; adults at increased risk of type 2 diabetes and heart disease [10]; adults with overweight or obesity [7].
- Sources
- [2], [7], [10]
- Caveats
- The Cochrane review rated the lipid evidence low or very low quality for most comparisons [2]. The changes are small next to drug effects.
Blood lipids
Shown to raise HDL and lower triglycerides and LDL in people with vascular disease on statins, though events did not fall.
The numbers and sources
- Effect
- At 2 years in AIM-HIGH, median HDL rose from 35 to 42 mg/dL, triglycerides fell from 164 to 122 mg/dL and LDL fell from 74 to 62 mg/dL on 1,500 to 2,000 mg a day of extended-release niacin [1]. In HPS2-THRIVE, LDL averaged 10 mg/dL lower and HDL 6 mg/dL higher than placebo [2].
- Population
- 3,414 people with cardiovascular disease on simvastatin [1]; 25,673 adults with vascular disease on statin-based therapy [2].
- Sources
- [1], [2]
- Caveats
- Lipid changes did not translate into fewer events in these trials (see next block).
Lower testosterone and HDL cholesterol
Shown to lower testosterone and HDL cholesterol in healthy men, more at higher doses. Levels returned to baseline after stopping.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- LGD-4033 lowered total testosterone, sex hormone-binding globulin, HDL cholesterol and triglycerides in a dose-dependent way. FSH and free testosterone fell at the highest dose. Levels returned to baseline after stopping [1]. The 2026 review reports suppression of testosterone, sex hormone-binding globulin and HDL cholesterol across randomized trials, with reversible rises in liver enzymes for some compounds [4].
- Population
- 76 healthy young men over 21 days and 5 weeks of follow-up [1]; trials summarized in a review [4].
- Sources
- [1], [4]
- Caveats
- Trial doses were lower and shorter than the stacked, unmonitored use the review describes [4].
LDL cholesterol lowering
Shown to lower LDL cholesterol by about 51 to 56 mg/dL with atorvastatin and rosuvastatin, and triglycerides by about 25 to 32 mg/dL.
Triglycerides fell by 24.76 and 31.98 mg/dL, and HDL rose by 1.85 and 3.87 mg/dL.
The numbers and sources
- Effect
- Pooled across studies, atorvastatin lowered LDL cholesterol by 51.49 mg/dL (95% CI 42.75 to 60.23) and rosuvastatin by 55.66 mg/dL (95% CI 46.32 to 65.00). Triglycerides fell by 24.76 and 31.98 mg/dL, and HDL rose by 1.85 and 3.87 mg/dL [3].
- Population
- Studies of atorvastatin and rosuvastatin from 2003 to 2025 [3].
- Sources
- [3]
- Caveats
- The abstract does not give study counts, doses or the comparison used. The heart attack and stroke results above are expressed per unit of LDL lowered [1].
Blood fats in hypertension
Shown in two meta-analyses to lower LDL cholesterol and triglycerides in people with hypertension. HDL cholesterol results differed between them.
Compared with control groups the source abstract does not describe [5]; no intervention [6]
Baduanjin lowered triglycerides and LDL cholesterol and raised HDL cholesterol against no intervention.
The numbers and sources
- Effect
- Tai chi was associated with lower total cholesterol (WMD -0.49), triglycerides (WMD -0.49, 95% CI -0.92 to -0.07) and LDL cholesterol (WMD -0.86), and no significant effect on HDL cholesterol (P = 0.16) [5]. Baduanjin lowered triglycerides and LDL cholesterol and raised HDL cholesterol against no intervention [6].
- Population
- Adults with essential hypertension [5][6].
- Sources
- [5], [6]
- Caveats
- The first abstract gives no units, and its HDL interval does not contain its own point estimate [5]. The second gives no sizes for blood fats [6].
Triglycerides and cholesterol
Shown to lower triglycerides about 12% more than placebo in adults with HIV. These are lab changes, and long-term heart effects are not established.
The numbers and sources
- Effect
- At 26 weeks, triglycerides changed by -50 mg/dL on tesamorelin and +9 mg/dL on placebo, and the total to HDL cholesterol ratio by -0.31 against +0.21 [1]. Pooled across both trials, triglycerides changed by -37 against +6 mg/dL, a treatment effect of -12.3% [3].
- Population
- As above [1][3].
- Sources
- [1], [3]
- Caveats
- Laboratory changes only. The label states that long-term cardiovascular safety has not been established [6].
Cholesterol
Limited evidence: a 50-trial review found lower total and LDL cholesterol and triglycerides, while an earlier review found no effect on lipids.
The numbers and sources
- Effect
- Across 50 trials, grape seed extract lowered total cholesterol (WMD -6.03, 95% CI -9.71 to -2.35), LDL cholesterol (WMD -4.97) and triglycerides (WMD -6.55). HDL did not change [5]. An earlier meta-analysis of 9 RCTs found no significant effect on lipid levels [2].
- Population
- Adults in RCTs [5][2].
- Sources
- [5], [2]
- Caveats
- The two reviews disagree.
Shown to raise it4
Blood fats and blood pressure
Shown to raise triglycerides, total and LDL cholesterol and blood pressure in trials of higher against lower sugar intake, independent of body weight.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Higher sugar intake raised triglycerides by 0.11 mmol/L (95% CI 0.07 to 0.15), total cholesterol by 0.16 mmol/L (95% CI 0.10 to 0.24), LDL cholesterol by 0.12 mmol/L (95% CI 0.05 to 0.19) and HDL cholesterol by 0.02 mmol/L (95% CI 0.00 to 0.03). In trials of 8 weeks or longer, systolic pressure rose 6.9 mmHg (95% CI 3.4 to 10.3) and diastolic 5.6 mmHg [11]. A liter of regular cola a day for 6 months raised triglycerides 32% and total cholesterol 11% more than milk, diet cola or water [12].
- Population
- 37 trials reporting lipids and 12 reporting blood pressure, each at least 2 weeks [11]. 47 overweight adults [12].
- Sources
- [11], [12]
- Caveats
- Heterogeneity was moderate to high (I² 36% to 75%) [11]. The cola trial was small.
Raised triglycerides and cholesterol
Shown to raise triglycerides markedly in 25% of people in trials, lower HDL in 15% and raise cholesterol in 7%. The changes reversed after stopping.
The numbers and sources
- How common
- Very common: more than 1 in 10 people.
- Effect
- In clinical trials, marked rises in serum triglycerides occurred in 25%, falls in HDL in 15% and rises in cholesterol in 7%, reversing after the drug was stopped. Triglycerides above 800 mg/dL have been reported, and the rise is dose related [3]. A meta-analysis found statistically significant changes in mean lipid values during treatment, with means of 119.98 mg/dL for triglycerides and 184.74 mg/dL for total cholesterol, and found the mean changes did not reach its high-risk thresholds and few people had abnormal results [9].
- Population
- Isotretinoin capsule trials [3]; 1,574 patients aged 9 to 35 in 26 studies [9].
- Sources
- [3], [9]
- Caveats
- The meta-analysis abstract gives values during treatment, not the size of the change from baseline [9]. The label states the heart consequences are unknown [3].
Raised cholesterol and triglycerides
Shown to raise nonfasting cholesterol to 20% or more above the normal limit in 15% against 7% on placebo, and triglycerides to 500 mg/dL or more in 6% against 3%.
The numbers and sources
- How common
- Very common: more than 1 in 10 people.
- Effect
- In US controlled studies, nonfasting cholesterol rose to at least 20% above the upper limit of normal in 15% on mirtazapine and 7% on placebo, and nonfasting triglycerides rose to 500 mg/dL or more in 6% against 3% [7].
- Population
- Adults in US controlled studies of mirtazapine [7].
- Sources
- [7]
- Caveats
- Nonfasting samples in short trials. No trial here measured heart attacks or strokes.
Hormone and blood fat changes on low-sodium diets
Shown to raise renin, aldosterone, noradrenaline, total cholesterol and triglycerides slightly when sodium was cut sharply in trials. LDL and HDL cholesterol did not change significantly.
Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3, 27 trials) and triglycerides 7.10 mg/dL (95% CI 3.1 to 11.1, 20 trials).
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- During sodium reduction, renin rose 1.56 ng/mL/hour (82 trials), aldosterone 104 pg/mL (66 trials) and noradrenaline 62.3 pg/mL (35 trials). Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3, 27 trials) and triglycerides 7.10 mg/dL (95% CI 3.1 to 11.1, 20 trials). LDL cholesterol changed by 2.46 mg/dL (95% CI -1 to 5.9) and HDL by -0.3 mg/dL (95% CI -1.66 to 1.05) [5].
- Population
- 917 participants for cholesterol, 712 for triglycerides and 2,904 for renin, in randomized trials of low against high sodium diets [5].
- Sources
- [5]
- Caveats
- Many trials were short and cut sodium further than guidelines ask. The review authors note these changes were more consistent than the blood pressure effect in people with normal blood pressure [5].
Studies disagree4
Higher LDL cholesterol from unfiltered coffee
Shown to raise total and LDL cholesterol in trials, mainly with unfiltered brews such as boiled or French press coffee. Filtered coffee raised it very little.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Across 12 randomized trials averaging 45 days, coffee raised total cholesterol by 8.1 mg/dL (95% CI 4.5 to 11.6), LDL by 5.4 mg/dL (95% CI 1.4 to 9.5) and triglycerides by 12.6 mg/dL, more with unfiltered and caffeinated coffee and in people with high cholesterol [19]. An earlier pooling of 14 trials found a dose-response rise in total and LDL cholesterol with unfiltered coffee and very little with filtered coffee [20]. Five to 6 cups a day of cafetière coffee raised LDL by 0.26 mmol/L (95% CI 0.04 to 0.47) against filtered coffee over 24 weeks. Triglycerides first rose 26% and then returned near baseline [18].
- Population
- 1,017 participants in 12 Western trials [19]. 14 trials [20]. 46 adults aged 19 to 69 [18].
- Sources
- [19], [20], [18]
- Caveats
- The trials attribute the rise to cafestol and kahweol, oily compounds present in unfiltered coffee [21]. The lipid trials were all in Western countries [19].
LDL cholesterol
Shown to lower LDL cholesterol slightly, by 0.09 mmol/L, against refined-grain control foods in pooled trials, with whole-grain oats lowering cholesterol most.
Compared with non-whole-grain control foods [8]; refined grains or placebo [9]
Triglycerides tended to fall (-0.04 mmol/L, 95% CI -0.08 to 0.01).
The numbers and sources
- Effect
- Whole grain intake lowered LDL cholesterol by 0.09 mmol/L (about 3.5 mg/dL, 95% CI -0.15 to -0.03) and total cholesterol by 0.12 mmol/L (95% CI -0.19 to -0.05), with no effect on HDL cholesterol. Triglycerides tended to fall (-0.04 mmol/L, 95% CI -0.08 to 0.01). Oats had the largest effect on total cholesterol (-0.17 mmol/L) [8]. In a second review, whole-grain oats improved total cholesterol (SMD -0.54, 95% CI -0.95 to -0.12) and LDL cholesterol (SMD -0.57, 95% CI -0.84 to -0.31), and whole-grain rice improved triglycerides [9].
- Population
- 24 randomized trials in apparently healthy adults [8]. 25 randomized trials of 2 to 16 weeks in adults with or without cardiovascular risk factors [9].
- Sources
- [8], [9]
- Caveats
- Small changes over weeks. The second review found the LDL effect for oats, not for all whole grains combined [9]. Beta-glucan from oats is on its own page.
Cholesterol and blood pressure in trials
Not shown to change cholesterol or blood pressure against all comparison diets combined. Against plant proteins, LDL fell less on red meat. Against fish, it fell more.
Compared with diets replacing red meat with legumes, soy or nuts, fish, poultry, mixed animal protein, refined carbohydrates or the usual diet [4]
The numbers and sources
- Effect
- Against all comparison diets combined, red meat made no significant difference to total, LDL or HDL cholesterol, apolipoproteins A1 and B, or blood pressure, and gave a smaller fall in triglycerides (0.065 mmol/L). Against high-quality plant proteins, total cholesterol fell 0.264 mmol/L less and LDL 0.198 mmol/L less. Against fish, LDL fell 0.173 mmol/L more and HDL 0.065 mmol/L more. Against refined carbohydrates, triglycerides fell 0.181 mmol/L more [4].
- Population
- 1,803 participants in 36 randomized trials [4].
- Sources
- [4]
- Caveats
- The result depends on what replaced the red meat. Trials measured blood markers, not heart events.
Blood sugar, cholesterol and blood pressure
Not shown to change HbA1c, fasting glucose, cholesterol or blood pressure against placebo, with one spore oil trial finding lower lipids.
In 110 adults with dyslipidemia, a spore oil extract for 12 weeks lowered total cholesterol, triglycerides and LDL and raised HDL compared with placebo.
The numbers and sources
- Effect
- In a Cochrane review of 5 trials (398 participants), 1.4 to 3 g a day for 12 to 16 weeks did not change HbA1c (WMD -0.10%, 95% CI -1.05 to 0.85), total cholesterol, LDL or BMI against placebo. Fasting glucose, blood pressure and triglycerides did not differ. Post-meal glucose results were inconsistent [2]. A 2025 meta-analysis of 17 RCTs (971 participants) at 200 to 11,200 mg a day for 1 to 24 weeks found no effect on blood pressure, fasting glucose or the lipid profile. BMI fell by 0.43 (95% CI 0.10 to 0.77) and heart rate by 3.92 beats a minute (95% CI 0.40 to 7.45) [3]. In 110 adults with dyslipidemia, a spore oil extract for 12 weeks lowered total cholesterol, triglycerides and LDL and raised HDL compared with placebo. The abstract gives no effect sizes [4].
- Population
- Adults with type 2 diabetes in the analyzed trials [2]. Healthy, at-risk and chronically ill adults [3]. Adults with dyslipidemia [4].
- Sources
- [2], [3], [4]
- Caveats
- Data in [2] came from 3 small trials, and risk of bias was unclear in 4 of 5 [2]. The 2025 review rated the certainty of evidence very low for every outcome [3]. The spore oil trial tested a different product and disagrees with both reviews on lipids [4].
Tested, and not shown to change it16
Cholesterol
Shown to lower total cholesterol by about 6 mg/dL in adults, with no change in LDL or HDL.
A 2025 meta-analysis of 25 trials found total cholesterol 6.72 mg/dL lower (95% CI -12.91 to -0.53, I² 50.8%), with no significant change in LDL, HDL or triglycerides.
The numbers and sources
- Effect
- ACV lowered total cholesterol by 6.06 mg/dL (95% CI -10.95 to -1.17) with no significant effect on LDL or HDL [2]. A 2025 meta-analysis of 25 trials found total cholesterol 6.72 mg/dL lower (95% CI -12.91 to -0.53, I² 50.8%), with no significant change in LDL, HDL or triglycerides [4].
- Population
- Adults in 9 studies [2]. 1,320 adults in 25 trials [4].
- Sources
- [2], [4]
- Caveats
- Triglyceride reductions appeared only in subgroups [2][4].
LDL cholesterol (oat beta-glucan)
Shown to lower LDL by about 0.2 to 0.25 mmol/L in adults at 3 g a day or more of oat beta-glucan.
The numbers and sources
- Effect
- In 28 trials, 3 g a day or more of oat beta-glucan lowered LDL by 0.25 mmol/L (95% CI 0.20 to 0.30) and total cholesterol by 0.30 mmol/L, with no change in HDL or triglycerides. Dose (3.0 to 12.4 g a day) and duration (2 to 12 weeks) did not change the result [1]. In 58 trials (3,974 people), a median 3.5 g a day lowered LDL by 0.19 mmol/L (95% CI 0.14 to 0.23), non-HDL by 0.20 mmol/L and apoB by 0.03 g/L [2].
- Population
- Adults, mostly with normal to raised cholesterol [1][2].
- Sources
- [1], [2]
- Caveats
- LDL heterogeneity was high in [2] (I² 79%). [1] was supported by DSM Nutritional Products and searched in-house reports at CreaNutrition, a subsidiary of an oat fiber company. FDA's health claim rests on 3 g a day or more from whole oats or barley [3].
Higher LDL cholesterol in feeding trials
Shown to raise LDL cholesterol by about 8 mg/dL in randomized trials in healthy people, along with total cholesterol and apolipoprotein B.
Across 66 trials, eggs raised total cholesterol, LDL and apolipoprotein B100, did not change triglycerides, and LDL rose nonlinearly with dose.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Against control groups, eating more eggs raised LDL cholesterol (mean difference 8.14 mg/dL, P < 0.0001), with larger effects in trials of over two months [3]. Across 66 trials, eggs raised total cholesterol, LDL and apolipoprotein B100, did not change triglycerides, and LDL rose nonlinearly with dose [4]. Each extra 100 mg of dietary cholesterol a day raised total cholesterol by 2.2 mg/dL (95% CI 1.8 to 2.5) [2].
- Population
- Healthy participants in 17 randomized trials [3]. 3,185 participants in 66 randomized trials [4]. 556 participants in 17 feeding studies [2].
- Sources
- [3], [4], [2]
- Caveats
- Short trials. One review found the rise came with eating more than one egg a day for under 12 weeks [4].
LDL cholesterol
Shown to lower LDL cholesterol by about 0.33 mmol/L with about 10 g of psyllium a day in adults with or without high cholesterol.
Triglycerides and HDL did not change significantly.
The numbers and sources
- Effect
- Across 28 trials (1,924 participants), a median 10.2 g of psyllium a day lowered LDL cholesterol by 0.33 mmol/L (95% CI -0.38 to -0.27), non-HDL cholesterol by 0.39 mmol/L and apoB by 0.05 g/L (95% CI -0.08 to -0.03) [1]. A 2025 meta-analysis of 41 RCTs (2,049 participants) found LDL cholesterol 8.55 mg/dL lower (95% CI -12.92 to -4.19) and total cholesterol 9.05 mg/dL lower. Triglycerides and HDL did not change significantly [2].
- Population
- Adults with or without high cholesterol in RCTs of 3 weeks or longer [1]; adults in 41 RCTs [2].
- Sources
- [1], [2]
- Caveats
- LDL and non-HDL estimates were graded moderate quality because of inconsistency, and apoB high quality [1]. Heterogeneity in the 2025 review was considerable (I² 88% for LDL), and dose and duration did not explain it [2].
LDL and total cholesterol
Shown to lower LDL cholesterol about 0.26 to 0.30 mmol/L against usual diets in adults with cardiometabolic risk factors.
Compared with control groups the source does not describe [1]; a usual or habitual Nordic diet, a usual Western diet or general healthy eating advice [2]; the participants' usual Western diet, in Swedish adults [3]; an average Nordic diet with the same calories [4]
The numbers and sources
- Effect
- In 5 RCTs (513 participants), a Nordic diet lowered total cholesterol by 0.38 mmol/L (95% CI -0.76 to -0.01) and LDL by 0.30 mmol/L (95% CI -0.54 to -0.06), with no change in HDL or triglycerides [1]. In 6 RCTs (717 participants), LDL fell 0.26 mmol/L (95% CI -0.52 to -0.00), with reductions in non-HDL cholesterol and apolipoprotein B [2]. In NORDIET, LDL fell 21% and HDL 5% over 6 weeks against usual diets [3]. In SYSDIET, non-HDL cholesterol fell 0.18 mmol/L (95% CI -0.35 to -0.01) against an average Nordic diet [4].
- Population
- Adults, mostly in Nordic countries, with raised cholesterol, metabolic syndrome or central obesity [1][2]; 88 Swedish adults with mild high cholesterol [3]; 200 adults with metabolic syndrome features [4].
- Sources
- [1], [2], [3], [4]
- Caveats
- Both meta-analyses pooled largely the same few trials. Heterogeneity was high (I² 89%) and certainty low for LDL in [2]. NORDIET lowered HDL along with LDL [3].
Blood pressure and cardiometabolic markers
Not shown to change blood pressure, cholesterol or body fat in adults. Fasting glucose and CRP fell very slightly.
The numbers and sources
- Effect
- Across 10 RCTs, tart cherry juice did not change blood pressure, cholesterol, triglycerides or body fat. Fasting glucose fell by 0.51 mg/dL [4]. Across 21 trials, blood pressure, heart rate, hs-CRP and IL-6 did not change, while CRP fell by 0.39 mg/L (95% CI -0.74 to -0.05, moderate certainty) [5]. A 3-month trial in 50 middle-aged adults found no change in vascular or metabolic measures [6].
- Population
- Adults across 10 to 21 RCTs [4][5]; middle-aged adults, 30 mL concentrate twice a day [6].
- Sources
- [4], [5], [6]
- Caveats
- A 0.51 mg/dL glucose change is very small. The 3-month trial was funded by the Cherry Research Committee [6].
Higher cholesterol
Shown to raise total cholesterol, about 14 mg/dL in one review, at 4 g a day or more. Reviews differ on whether LDL rises.
LDL, HDL and triglycerides did not change significantly.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- At 4 g a day or more, betaine raised total cholesterol by 0.34 mmol/L (95% CI 0.02 to 0.65). LDL, HDL and triglycerides did not change significantly [7]. A second meta-analysis found total cholesterol 14.12 mg/dL higher (95% CI 9.23 to 19.02) and LDL 10.26 mg/dL higher (95% CI 6.14 to 14.38). Triglycerides, HDL, glucose, CRP, liver enzymes and blood pressure did not change [2].
- Population
- Adults in 6 RCTs from 2002 to 2018 [7]; RCTs pooled up to February 2021 [2].
- Sources
- [7], [2]
- Caveats
- The reviews differ on LDL. Subgroup analysis suggested the rise appears at 4 g a day or more [2]. In uncontrolled liver pilot trials at 2 to 8 g a day, LDL did not change and HDL rose at 2 and 4 g [6].
LDL cholesterol
Shown to lower LDL cholesterol about 0.24 to 0.30 mmol/L against omnivorous or control diets in adults.
Compared with the participants' habitual diet, unchanged, in 3 trials in US and New Zealand adults, and in 8 trials a National Cholesterol Education Program diet, American Diabetes Association and Korean Diabetes Association diets, a portion-controlled diet, a Mediterranean diet, a low-fat diet, a healthy omnivorous diet or a high-carbohydrate lacto-ovo vegetarian diet [1]; an omnivorous diet [3]
The numbers and sources
- Effect
- Vegan diets lowered total cholesterol by 0.30 mmol/L and LDL by 0.24 mmol/L (95% CI -0.40 to -0.07), with no change in HDL or triglycerides [1]. In 30 RCTs of vegetarian or vegan diets, LDL fell 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B 12.92 mg/dL, with similar effects across intervention diet types [3].
- Population
- Adults with overweight or type 2 diabetes [1]; adults in 30 RCTs [3].
- Sources
- [1], [3]
- Caveats
- The larger review pooled vegan and vegetarian diets [3].
LDL cholesterol
Shown to lower LDL cholesterol about 0.3 mmol/L against omnivorous diets in adults. HDL also fell slightly in one review.
Compared with control diets the source does not describe [2]; an omnivorous control diet containing meat and dairy products [3]; an omnivorous diet [4]
The numbers and sources
- Effect
- In 11 trials, vegetarian diets lowered total cholesterol by 0.36 mmol/L, LDL by 0.34 mmol/L (95% CI -0.57 to -0.11) and HDL by 0.10 mmol/L (95% CI -0.14 to -0.06), with no triglyceride change [3]. In 30 RCTs, vegetarian or vegan diets lowered LDL by 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B by 12.92 mg/dL, with similar effects across intervention diet types and no triglyceride change [4]. In people with diabetes, LDL fell 0.12 mmol/L (95% CI -0.20 to -0.04) [2].
- Population
- Adults in randomized trials [3][4]; adults with diabetes [2].
- Sources
- [2], [3], [4]
- Caveats
- The reviews pooled lacto-ovo and vegan diets, though [4] found effects similar across diet types.
Weight loss compared with no diet or brief advice
Shown to lower body weight against control diets in adults with overweight or obesity. As one-off self-help instructions, it matched standard brief advice at one year.
Compared with a daily energy-restricted diet or a routine diet [7]; standard brief weight-management advice [8]
Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ.
The numbers and sources
- Effect
- In 20 articles with 1,393 participants, 5:2 lowered body weight, BMI, waist circumference, body fat percentage, fat mass, fat-free mass, LDL cholesterol, systolic blood pressure and HOMA-IR against control groups. Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ [7]. One-off 5:2 self-help instructions lost 1.9 kg at one year against 1.8 kg with standard brief advice (p 0.79), and 18% against 15% lost at least 5% of body weight [8].
- Population
- Adults with overweight or obesity in 20 trials [7]; 300 UK adults with obesity followed for one year [8].
- Sources
- [7], [8]
- Caveats
- The meta-analysis abstract reports significance without effect sizes [7]. Adherence to self-help 5:2 fell over the year [8].
HDL cholesterol in trials
Shown to raise HDL cholesterol by about 0.09 mmol/L in trials of adults without heart disease, with no change in triglycerides.
Compared with periods without alcohol [9]
It lowered fibrinogen (-0.20 g/L) and did not change triglycerides.
The numbers and sources
- Effect
- Alcohol raised HDL cholesterol (mean difference 0.094 mmol/L, 95% CI 0.064 to 0.123), apolipoprotein A1 (0.101 g/L, 95% CI 0.073 to 0.129) and adiponectin, with a dose-response for HDL. It lowered fibrinogen (-0.20 g/L) and did not change triglycerides. Results were similar for wine, beer and spirits [9].
- Population
- 44 interventional studies of 13 markers in adults without known cardiovascular disease [9].
- Sources
- [9]
- Caveats
- These are blood markers, not heart attacks. The review calls them indirect support for a protective effect [9], while genetic studies of heart disease found none (see above).
LDL and total cholesterol
Shown to lower LDL cholesterol slightly in adults, by 0.10 mmol/L across trials and 0.28 mmol/L in the original feeding trial.
Compared with control diets the source does not describe [3]; the DASH trial's control diet [6]; usual, low-fat and low-antioxidant diets, behavioral programs alone and usual gestational diabetes care [7]
An umbrella review reported the same pooled figures as, with no effect on HDL or triglycerides.
The numbers and sources
- Effect
- Across 20 trials, DASH lowered total cholesterol by 0.20 mmol/L (95% CI -0.31 to -0.10) and LDL by 0.10 mmol/L (95% CI -0.20 to -0.01) [3]. In the 8-week DASH feeding trial, total cholesterol fell 0.35 mmol/L (13.7 mg/dL) and LDL 0.28 mmol/L (10.7 mg/dL) against control, with no triglyceride change. LDL fell 11.2 mg/dL more in men than in women [6]. An umbrella review reported the same pooled figures as [3], with no effect on HDL or triglycerides [7].
- Population
- Adults in 20 trials of 2 to 24 weeks [3]; 436 adults with total cholesterol of 6.7 mmol/L or less, mean age 44.6, 60% African American [6].
- Sources
- [3], [6], [7]
- Caveats
- The umbrella review drew its lipid figures from the same meta-analysis, so the two are not independent [3][7]. The umbrella review rated most secondary outcomes very low to moderate certainty [7].
Cholesterol
Shown to lower total cholesterol by 2.8 mg/dL in trials of catechin-enriched green tea drinks. LDL, HDL and triglycerides did not change significantly in those trials.
Compared with water or other placebo drinks, no intervention, or green tea drinks low in catechins [4]
LDL changed by -2.61 mg/dL (95% CI -5.49 to 0.27), HDL by -0.84 mg/dL and triglycerides by -0.77 mg/dL, none significant.
The numbers and sources
- Effect
- In the 9 trials that gave green tea as a drink, total cholesterol fell by 2.80 mg/dL (95% CI 0.16 to 5.43). LDL changed by -2.61 mg/dL (95% CI -5.49 to 0.27), HDL by -0.84 mg/dL and triglycerides by -0.77 mg/dL, none significant. Across all 31 trials of drinks and capsules, LDL fell by 4.55 mg/dL (95% CI 2.80 to 6.31) [4].
- Population
- 3,321 participants in 31 randomized trials, 9 of them using a green tea drink [4].
- Sources
- [4]
- Caveats
- The drinks in these trials were green tea beverages made with extract, carrying 400 to 928 mg of catechins a day, not ordinary brewed tea. Meta-regression found no significant difference between drinks and capsules [4]. Capsule trials are on the green tea extract page.
Inflammation and blood lipids
Mixed results: reviews disagree on whether CRP falls, and most found no change in LDL or triglycerides.
The numbers and sources
- Effect
- One meta-analysis found no change in CRP (WMD -0.144 mg/L, 95% CI -0.968 to 0.680), total cholesterol, LDL, triglycerides or glucose. HDL fell slightly (WMD -4.18 mg/dL, 95% CI -6.54 to -1.82) [4]. A later meta-analysis found lower TNF-α (WMD -0.44, 95% CI -0.71 to -0.16) and hs-CRP (WMD -0.27, 95% CI -0.5 to -0.02), with no change in IL-6 [6]. In 25 RCTs in metabolic disorders, CRP fell (SMD -0.18, 95% CI -0.33 to -0.03), and IL-6 and TNF-α did not change significantly [7]. In 6 RCTs in type 2 diabetes (533 participants), CRP fell (SMD -1.40, 95% CI -2.60 to -0.21) [8]. Apolipoprotein B (WMD 2.11 mg/dL, 95% CI -1.53 to 5.75) and apolipoprotein A-I did not change in 7 RCTs [9]. An umbrella review rated as high certainty a 0.19 mmol/L drop in total cholesterol in adults with overweight (95% CI 0.06 to 0.32) [5].
- Population
- 10 RCTs [4]; 17 RCTs with 736 adults [6]; adults with metabolic disorders [7]; adults with type 2 diabetes [8]; 7 RCTs [9]; meta-analyses of RCTs [5].
- Sources
- [4], [6], [7], [8], [9], [5]
- Caveats
- The reviews disagree on CRP, and the CRP effect in [8] is several times the size of that in [7]. Heterogeneity in [6] was about 50%. Evidence in [8] was low certainty. CRP is a marker, not a clinical outcome [7].
Blood sugar and blood fats in type 2 diabetes
Shown in one meta-analysis to lower HbA1c by 0.47 points and fasting glucose by 24 mg/dL in adults with type 2 diabetes, with high heterogeneity.
Compared with control groups including usual care or standard treatment [12]
Triglycerides did not differ (-12.57 mg/dL, 95% CI -29.91 to 4.76).
The numbers and sources
- Effect
- Pooled differences were -23.72 mg/dL for fasting blood glucose (95% CI -37.78 to -9.65, I² 82%), -0.47% for HbA1c (95% CI -0.87 to -0.07, I² 82%), -17.38 mg/dL for glucose after meals, -18.50 mg/dL for total cholesterol, +4.30 mg/dL for HDL cholesterol and -12.95 mg/dL for LDL cholesterol. Triglycerides did not differ (-12.57 mg/dL, 95% CI -29.91 to 4.76) [12].
- Population
- 864 adults with type 2 diabetes in 12 trials [12].
- Sources
- [12]
- Caveats
- The authors note limited methods and heterogeneity, and long-term effects were not studied [12].
LDL cholesterol, wet cupping
One small trial found LDL cholesterol fell after wet cupping in 47 healthy young men, with no significant change in total cholesterol, HDL or triglycerides.
Compared with no treatment [12]
Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly.
The numbers and sources
- Effect
- Over 3 weeks after one wet cupping session, LDL cholesterol and the LDL to HDL ratio fell in the treated group against untreated controls (p < 0.0001). Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly [12].
- Population
- 47 healthy men aged 18 to 25 [12].
- Sources
- [12]
- Caveats
- One small trial in young men without high cholesterol, with no sham. Wet cupping removes blood, and the authors compare it with phlebotomy [12].
How it compares with the reference method
Matched the reference method1
Fasting against not fasting
Shown to read higher after eating: triglycerides rose at most 0.3 mmol/L (26 mg/dL) above fasting levels, for up to 6 hours after a meal.
The numbers and sources
- Compared with
- A fasting blood sample
- Effect
- In 33,391 Danish adults, triglycerides were increased for up to 6 hours after the last meal, with a maximum change from fasting of 0.3 mmol/L [23]. A joint European consensus statement put the maximal mean change 1 to 6 hours after habitual meals at 0.3 mmol/L (26 mg/dL), judged it not clinically significant, and reported that fasting and non-fasting results are comparable in predicting cardiovascular disease [6]. In 68 pooled cohorts, hazard ratios were at least as strong in participants who did not fast as in those who did [11].
- Population
- 33,391 adults aged 20 to 95 in the Copenhagen General Population Study [23].
- Sources
- [23], [6], [11]
- Caveats
- A cross-sectional comparison of people sampled at different times after eating, not the same people tested twice, and the figure is an average after ordinary meals [23]. The consensus sets separate cut points for the two kinds of sample, and an Endocrine Society guideline bases diagnosis on fasting levels [6][7].
Mixed results1
Variation from one test to the next
Mixed results: a review of 30 studies put within-person variation of triglycerides at about 23%, against about 6% for total cholesterol.
The numbers and sources
- Compared with
- Repeat measurements in the same person
- Effect
- Pooling 30 studies published from 1970 to 1992, the average within-person biological variation was 22.6% for triglycerides, 6.1% for total cholesterol, 7.4% for HDL cholesterol and 9.5% for LDL cholesterol [24]. Over years, the within-person correlation of log triglyceride values was 0.64 (95% CI 0.60 to 0.68) across 4 years and 0.63 across 12 years, similar to blood pressure and total cholesterol [10].
- Population
- 30 published studies of repeat lipid measurements [24]. 1,933 people measured an average of 4 years apart and 379 measured 12 years apart [10].
- Sources
- [24], [10]
- Caveats
- The review is from 1993, and its estimates varied with each study's assay and design. Neither source states a threshold for agreement, so the result is given as numbers only [24].
What studies tie it to
Linked in research3
Coronary heart disease in genetic studies
Shown in genetic studies to track coronary heart disease, an effect that followed the number of ApoB-carrying particles more than triglycerides themselves.
The numbers and sources
- Effect
- Each copy of a variant in the APOA5 gene went with 16.0% higher triglycerides (95% CI 12.9 to 18.7) and an odds ratio for coronary heart disease of 1.18 (95% CI 1.11 to 1.26), in line with the hazard ratio of 1.10 seen for the same triglyceride difference in cohorts [13]. Across 185 common variants, the strength of a variant's effect on triglycerides correlated with its effect on coronary artery disease after accounting for LDL and HDL cholesterol [14]. In a Mendelian randomization analysis, triglyceride-lowering LPL variants and LDL-lowering LDLR variants went with the same lower risk per 10 mg/dL lower ApoB (odds ratios 0.771 and 0.773). After adjustment for ApoB, the association of triglycerides with coronary heart disease was null (OR 1.014, 95% CI 0.965 to 1.065) [15].
- Population
- 20,842 coronary heart disease patients and 35,206 controls [13]. Variants mapped in genome-wide studies of plasma lipids [14]. 654,783 participants, including 91,129 coronary heart disease cases, in 63 studies [15].
- Sources
- [13], [14], [15]
- Caveats
- Variants that change triglycerides also change other lipoproteins. The APOA5 variant went with lower HDL cholesterol and higher ApoB [13]. The authors of the largest analysis concluded that the benefit of lowering triglycerides may be proportional to the change in ApoB [15].
Acute pancreatitis
One cohort of 116,550 Danish adults linked non-fasting triglycerides of 177 mg/dL and above to more acute pancreatitis, about 9 times more at 443 mg/dL or above.
The numbers and sources
- Effect
- Against triglycerides below 89 mg/dL, multivariable adjusted hazard ratios for acute pancreatitis were 1.6 (95% CI 1.0 to 2.6) at 89 to 176 mg/dL, 2.3 (1.3 to 4.0) at 177 to 265 mg/dL and 8.7 (3.7 to 20.0) at 443 mg/dL or above, where the rate was 12 events per 10,000 person-years. The hazard ratio was 1.17 (95% CI 1.10 to 1.24) per 89 mg/dL higher triglycerides [21]. Guideline bodies place the level of clinically significant pancreatitis risk higher, at 500 mg/dL in a US panel and above 880 mg/dL in European documents [2][5][6].
- Population
- 116,550 people from two Copenhagen general population studies, median follow-up 6.7 years, 434 cases of acute pancreatitis [21].
- Sources
- [21], [2], [5], [6]
- Caveats
- Observational, with few events in the highest band, so its interval is wide. Results were similar after stratifying by alcohol intake and gallstone disease [21].
Death from any cause
Linked to more deaths at higher levels: 9% more at 150 to 199 mg/dL and 20% more at 200 mg/dL or above in a meta-analysis of cohorts.
The numbers and sources
- Effect
- Against triglycerides of 90 to 149 mg/dL, pooled risk ratios for death from any cause were 0.94 (95% CI 0.85 to 1.03) below 90 mg/dL, 1.09 (1.02 to 1.17) at 150 to 199 mg/dL and 1.20 (1.04 to 1.38) at 200 mg/dL or above. For cardiovascular death they were 0.83, 1.15 and 1.25. Risk of death from any cause rose 12% per 1 mmol/L higher triglycerides [22]. In a Danish cohort, adjusted hazard ratios for death at non-fasting triglycerides of 5 mmol/L or more, against below 1 mmol/L, were 3.3 in women and 1.8 in men [12].
- Population
- 61 prospective studies, with 58,419 deaths from any cause among 330,566 participants [22]. 13,981 adults in Copenhagen followed a mean 26 years [12].
- Sources
- [22], [12]
- Caveats
- Observational. The studies cannot separate triglycerides from the conditions that raise them.
Mixed results2
Coronary heart disease in cohort studies
Mixed results: pooled cohorts linked higher triglycerides to more coronary heart disease, but in the largest analysis the link disappeared after adjustment for other risk factors.
The numbers and sources
- Effect
- In a meta-analysis of 29 Western prospective studies, people in the top third of usual triglyceride values had an adjusted odds ratio for coronary heart disease of 1.72 (95% CI 1.56 to 1.90) against the bottom third. The authors noted that adjustment for established risk factors substantially weakened the association [10]. In 68 prospective studies, coronary heart disease rates per 1,000 person-years were 2.6 in the bottom third and 6.2 in the top third of triglycerides. After adjustment for several conventional factors, the hazard ratio per standard deviation higher triglycerides was 0.99 (95% CI 0.94 to 1.05), and the authors concluded that vascular risk can be assessed without regard to triglyceride [11]. In a Danish cohort followed for a mean 26 years, multifactorially adjusted hazard ratios for heart attack at non-fasting triglycerides of 5 mmol/L (442.5 mg/dL) or more, against below 1 mmol/L, were 5.4 in women and 2.4 in men [12].
- Population
- 262,525 participants with 10,158 coronary heart disease cases in 29 studies [10]. 302,430 people without vascular disease in 68 prospective studies [11]. 7,587 women and 6,394 men aged 20 to 93 in Copenhagen [12].
- Sources
- [10], [11], [12]
- Caveats
- Observational. Triglycerides travel with low HDL cholesterol, obesity and diabetes, so how much of the link belongs to triglycerides themselves depends on what an analysis adjusts for [10][11].
Cardiovascular events in trials that lowered triglycerides
Mixed results: fibrates cut cardiovascular events 10% in pooled trials and icosapent ethyl 25% in one, while pemafibrate lowered triglycerides 26% without fewer events.
The numbers and sources
- Effect
- Across 18 trials, fibrates reduced major cardiovascular events by 10% (95% CI 0 to 18) and coronary events by 13% (95% CI 7 to 19), with no effect on death from any cause [16]. Icosapent ethyl, 4 g a day, reduced a composite of cardiovascular events against placebo (17.2% against 22.0%, HR 0.75, 95% CI 0.68 to 0.83) in statin-treated patients with triglycerides of 135 to 499 mg/dL [17]. A different omega-3 formulation, 4 g a day against corn oil, made no difference (HR 0.99, 95% CI 0.90 to 1.09) and the trial was stopped early [18]. Pemafibrate lowered triglycerides by 26.2% against placebo and did not reduce cardiovascular events (HR 1.03, 95% CI 0.91 to 1.15), while ApoB rose 4.8% [19]. In a meta-regression of 49 trials, each 1 mmol/L reduction in triglycerides went with a risk ratio of 0.84 (95% CI 0.75 to 0.94) for major vascular events after accounting for LDL cholesterol. With the icosapent ethyl trial removed, the risk ratio was 0.91 (95% CI 0.81 to 1.006) [20].
- Population
- 45,058 participants in 18 fibrate trials [16]. 8,179 patients followed a median 4.9 years [17]. 13,078 statin-treated patients at high cardiovascular risk [18]. 10,497 patients with type 2 diabetes, triglycerides of 200 to 499 mg/dL and low HDL cholesterol, followed a median 3.4 years [19]. 374,358 patients in 49 trials [20].
- Sources
- [16], [17], [18], [19], [20]
- Caveats
- A marker that tracks risk is not always one whose lowering changes it. The meta-regression's authors concluded that the benefit of high-dose eicosapentaenoic acid appeared to exceed its lipid-lowering effect [20]. The icosapent ethyl and pemafibrate trials were funded by the drugs' makers [17][19].
Sources
- US Food and Drug Administration. 21 CFR 862.1705, Triglyceride test system. Electronic Code of Federal Regulations, with the FDA product classification entries for triglyceride test systems, including over-the-counter triglyceride tests (product code NGO). https://www.ecfr.gov/current/title-21/section-862.1705
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001. https://doi.org/10.1001/jama.285.19.2486
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019. https://doi.org/10.1161/CIR.0000000000000625
- Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026. https://doi.org/10.1161/CIR.0000000000001423
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal. 2020. https://doi.org/10.1093/eurheartj/ehz455
- Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points. A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. 2016. https://doi.org/10.1093/eurheartj/ehw152
- Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2012. https://doi.org/10.1210/jc.2011-3213
- Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies. A consensus statement from the European Atherosclerosis Society. European Heart Journal. 2021. https://doi.org/10.1093/eurheartj/ehab551
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. 2011. https://doi.org/10.1542/peds.2009-2107C
- Sarwar N, Danesh J, Eiriksdottir G, et al. Triglycerides and the Risk of Coronary Heart Disease: 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies. Circulation. 2007. https://doi.org/10.1161/CIRCULATIONAHA.106.637793
- Emerging Risk Factors Collaboration. Major Lipids, Apolipoproteins, and Risk of Vascular Disease. JAMA. 2009. https://doi.org/10.1001/jama.2009.1619
- Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women. JAMA. 2007. https://doi.org/10.1001/jama.298.3.299
- Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. The Lancet. 2010. https://doi.org/10.1016/S0140-6736(10)60545-4
- Do R, Willer CJ, Schmidt EM, et al. Common variants associated with plasma triglycerides and risk for coronary artery disease. Nature Genetics. 2013. https://doi.org/10.1038/ng.2795
- Ference BA, Kastelein JJP, Ray KK, et al. Association of Triglyceride-Lowering LPL Variants and LDL-C-Lowering LDLR Variants With Risk of Coronary Heart Disease. JAMA. 2019. https://doi.org/10.1001/jama.2018.20045
- Jun M, Foote C, Lv J, et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. The Lancet. 2010. https://doi.org/10.1016/S0140-6736(10)60656-3
- Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. New England Journal of Medicine. 2019. https://doi.org/10.1056/NEJMoa1812792
- Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial. JAMA. 2020. https://doi.org/10.1001/jama.2020.22258
- Das Pradhan A, Glynn RJ, Fruchart JC, et al. Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk. New England Journal of Medicine. 2022. https://doi.org/10.1056/NEJMoa2210645
- Marston NA, Giugliano RP, Im K, et al. Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials. Circulation. 2019. https://doi.org/10.1161/CIRCULATIONAHA.119.041998
- Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting Mild-to-Moderate Hypertriglyceridemia and Risk of Acute Pancreatitis. JAMA Internal Medicine. 2016. https://doi.org/10.1001/jamainternmed.2016.6875
- Liu J, Zeng FF, Liu ZM, et al. Effects of blood triglycerides on cardiovascular and all-cause mortality: a systematic review and meta-analysis of 61 prospective studies. Lipids in Health and Disease. 2013. https://doi.org/10.1186/1476-511X-12-159
- Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and Nonfasting Lipid Levels: Influence of Normal Food Intake on Lipids, Lipoproteins, Apolipoproteins, and Cardiovascular Risk Prediction. Circulation. 2008. https://doi.org/10.1161/CIRCULATIONAHA.108.804146
- Smith SJ, Cooper GR, Myers GL, Sampson EJ. Biological variability in concentrations of serum lipids: sources of variation among results from published studies and composite predicted values. Clinical Chemistry. 1993. https://doi.org/10.1093/clinchem/39.6.1012